Quality of Private and Public Ambulatory Health Care in Low and Middle Income Countries: Systematic Review of Comparative Studies
Background:
In developing countries, the private sector provides a substantial proportion
of primary health care to low income groups for communicable and
non-communicable diseases. These providers are therefore central to
improving health outcomes. We need to know how their services compare to
those of the public sector to inform policy options.
Methods and Findings:
We summarised reliable research comparing the quality of formal private
versus public ambulatory health care in low and middle income countries. We
selected studies against inclusion criteria following a comprehensive
search, yielding 80 studies. We compared quality under standard categories,
converted values to a linear 100% scale, calculated differences
between providers within studies, and summarised median values of the
differences across studies. As the results for for-profit and not-for-profit
providers were similar, we combined them. Overall, median values indicated
that many services, irrespective of whether public or private, scored low on
infrastructure, clinical competence, and practice. Overall, the private
sector performed better in relation to drug supply, responsiveness, and
effort. No difference between provider groups was detected for patient
satisfaction or competence. Synthesis of qualitative components indicates
the private sector is more client centred.
Conclusions:
Although data are limited, quality in both provider groups seems poor, with
the private sector performing better in drug availability and aspects of
delivery of care, including responsiveness and effort, and possibly being
more client orientated. Strategies seeking to influence quality in both
groups are needed to improve care delivery and outcomes for the poor,
including managing the increasing burden of non-communicable diseases.
: Please see later in the article for the Editors' Summary
Vyšlo v časopise:
Quality of Private and Public Ambulatory Health Care in Low and Middle Income Countries: Systematic Review of Comparative Studies. PLoS Med 8(4): e32767. doi:10.1371/journal.pmed.1000433
Kategorie:
Research Article
prolekare.web.journal.doi_sk:
https://doi.org/10.1371/journal.pmed.1000433
Souhrn
Background:
In developing countries, the private sector provides a substantial proportion
of primary health care to low income groups for communicable and
non-communicable diseases. These providers are therefore central to
improving health outcomes. We need to know how their services compare to
those of the public sector to inform policy options.
Methods and Findings:
We summarised reliable research comparing the quality of formal private
versus public ambulatory health care in low and middle income countries. We
selected studies against inclusion criteria following a comprehensive
search, yielding 80 studies. We compared quality under standard categories,
converted values to a linear 100% scale, calculated differences
between providers within studies, and summarised median values of the
differences across studies. As the results for for-profit and not-for-profit
providers were similar, we combined them. Overall, median values indicated
that many services, irrespective of whether public or private, scored low on
infrastructure, clinical competence, and practice. Overall, the private
sector performed better in relation to drug supply, responsiveness, and
effort. No difference between provider groups was detected for patient
satisfaction or competence. Synthesis of qualitative components indicates
the private sector is more client centred.
Conclusions:
Although data are limited, quality in both provider groups seems poor, with
the private sector performing better in drug availability and aspects of
delivery of care, including responsiveness and effort, and possibly being
more client orientated. Strategies seeking to influence quality in both
groups are needed to improve care delivery and outcomes for the poor,
including managing the increasing burden of non-communicable diseases.
: Please see later in the article for the Editors' Summary
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